| NPI | 1932943974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 44540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29990) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2026-04-14 |